Individual provider Active NPI

Sean Joseph Lovallo, PA

  • Physician Assistant
  • Pensacola, FL
National Provider Identifier
1265769962
Registry record updated Aug 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9113427 Issued in FL
Practice address
4624 N Davis Hwy
Pensacola, FL 32503-2337
Phone
(850) 494-0000
Fax
(850) 494-0001
NPI assigned
Nov 17, 2009
Last updated
Aug 31, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 015389 NY
Physician Assistant 363A00000X 25MP00228500 NJ
Physician Assistant 363A00000X PA9113427 FL Primary

Addresses

Primary practice location

4624 N Davis Hwy
Pensacola, FL 32503-2337

Mailing address

4624 N Davis Hwy
Pensacola, FL 32503-2337
Phone (850) 494-0000

Other identifiers 1

IdentifierTypeStateIssuer
03497445MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address admin@pcofwfla.e-mdsdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200831002003 FL Practitioner - Physician Assistant 3476696709 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pain Consultants of West Florida P aGroup PAC ID 3274522206, 6 clinicians

Practice addresses (Care Compare)

4624 N Davis Hwy
Pensacola, FL 32503-2337
Phone (850) 494-0000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9113427FLMDPhysician Assistant
25MP00228500NJMDPhysician Assistant
015389NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Pain Consultants of West Florida CurrentSince Apr 11, 2021 Accepting new patients

Locations

4624 N Davis Hwy
Pensacola, FL 32503
Phone 85049400002014

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1258416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661904000000",
    "number": "1265769962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4624 N DAVIS HWY",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325032337",
            "telephone_number": "850-494-0000",
            "fax_number": "850-494-0001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4624 N DAVIS HWY",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325032337",
            "telephone_number": "850-494-0000",
            "fax_number": "850-494-0001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOVALLO",
        "first_name": "SEAN",
        "middle_name": "JOSEPH",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-11-17",
        "last_updated": "2022-08-31",
        "certification_date": "2022-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "015389",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00228500",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9113427",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03497445",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "admin@pcofwfla.e-mdsdirect.com",
            "affiliation": "N",
            "address_1": "4624 N Davis Hwy",
            "city": "Pensacola",
            "state": "FL",
            "country_code": "US",
            "postal_code": "325032353",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

Verify at the official NPI Registry.